Forensic Forensic PathologyPathology

““This is the place where This is the place where death rejoices to teach those death rejoices to teach those

who live.”who live.”

IntroductionIntroduction

A death that is unexpected or is A death that is unexpected or is thought to have been caused by thought to have been caused by injury or trauma is always injury or trauma is always investigated.investigated.

CoronerCoronerMedical ExaminerMedical Examiner

Coroner vs. Medical Coroner vs. Medical ExaminerExaminer

Coroner – a public official, appointed Coroner – a public official, appointed or elected, who makes inquires into or elected, who makes inquires into deaths and completes death deaths and completes death certificates.certificates. Determines cause/manner of deathDetermines cause/manner of death Decides if foul playDecides if foul play May or may not have medical trainingMay or may not have medical training

Coroner vs. Medical Coroner vs. Medical ExaminerExaminer

Medical Examiner – Medical Examiner – a physiciana physician, , evaluates medical history and physical evaluates medical history and physical exam of deceased to determine cause and exam of deceased to determine cause and manner of death.manner of death. Must receive special training to become a Must receive special training to become a

forensic pathologistforensic pathologist Forensic PathologyForensic Pathology – unnatural or suspicious – unnatural or suspicious

disease or injurydisease or injury In most large US cities, the medical In most large US cities, the medical

examiner is required to be a forensic examiner is required to be a forensic pathologist.pathologist.

Forensic PathologistForensic Pathologist

Education and TrainingEducation and Training Medical school – 4 yearsMedical school – 4 years

Post – medical training Post – medical training 3 to 5 year residency in general pathology3 to 5 year residency in general pathology

Additional year of trainingAdditional year of training In medical examiners office (forensic In medical examiners office (forensic

pathology)pathology) American Board of Pathology ExamAmerican Board of Pathology Exam Training / Knowledge in other areas of Training / Knowledge in other areas of

ForensicsForensics

In US 500 Forensic PathologistsIn US 500 Forensic Pathologists

About 25 of the 500 also have LAW About 25 of the 500 also have LAW DEGREESDEGREES

Deaths InvestigatedDeaths Investigated

Two Main CategoriesTwo Main Categories 1. Persons who die suddenly when in 1. Persons who die suddenly when in

apparent good apparent good health, those who are health, those who are unexpected to die, or those unexpected to die, or those who are who are without medical treatment for fatal without medical treatment for fatal diseases. diseases.

Public Health Threat (bacterial meningitus)Public Health Threat (bacterial meningitus) Death in public places (electrocution in public Death in public places (electrocution in public

place)place) Maternal DeathMaternal Death Death outside of medical facilityDeath outside of medical facility

Deaths InvestigatedDeaths Investigated

2. Deaths caused by unnatural causes2. Deaths caused by unnatural causes

Examples:Examples: Acts of violenceActs of violence Drug relatedDrug related Trauma / AsphyxiationTrauma / Asphyxiation WeatherWeather Vehicular accidentVehicular accident

Deaths InvestigatedDeaths Investigated

Special Categories:Special Categories: Under 18Under 18 Death of an individual under legally Death of an individual under legally

dependent care.dependent care. Death in correctional facilityDeath in correctional facility On aircraft or shipOn aircraft or ship

MURDERS ARE THE SMALLEST MURDERS ARE THE SMALLEST NUMBER OF DEATHS NUMBER OF DEATHS INVESTIGATED!INVESTIGATED!

Three facets of guilt:Three facets of guilt:

MotiveMotive MeansMeans OpportunityOpportunity

Medical Examiner’s Duties:Medical Examiner’s Duties:

Review eyewitness statementsReview eyewitness statements Examine crime sceneExamine crime scene AutopsyAutopsy PhotographyPhotography ReportReport TestimonyTestimony

Duties and Duties and ResponsibilitiesResponsibilities

Establish the cause of deathEstablish the cause of death Establish the time of deathEstablish the time of death Infer the type of weapon used Infer the type of weapon used Determine the manner of deathDetermine the manner of death Identify the deceasedIdentify the deceased Determine the effects of trauma or Determine the effects of trauma or

pre-existing conditions.pre-existing conditions.

Postmortem LividityPostmortem Lividity(Livor Mortis)(Livor Mortis)

The Settling of blood that causes the The Settling of blood that causes the skin to change colorskin to change color

30 Minutes:30 Minutes:

Changes in skin color first appear Changes in skin color first appear

on fair-skinned persons on fair-skinned persons

4 to 8 hours:4 to 8 hours:

The blood in capillaries settles The blood in capillaries settles

PERMANENTLYPERMANENTLY

Between 1 and 8 hours:Between 1 and 8 hours:

(1) Blanching (1) Blanching Light-colored marks made by finger pressure

(2)(2)

Where a trained investigator will Where a trained investigator will begin..begin..

Why livor mortis is Why livor mortis is importantimportant

Has the Has the body been body been moved? moved?

Rigor MortisRigor Mortis The period of time that a body goes The period of time that a body goes

through a state of Rigidity through a state of Rigidity Caused by lactic acid build-up in the Caused by lactic acid build-up in the

body.body.

Rigor Mortis Rigor Mortis ProgressionProgression

Shorter muscles – face, fingers, toesShorter muscles – face, fingers, toes

NeckNeck

Then moves down and out the long Then moves down and out the long muscles of the legs and forearmsmuscles of the legs and forearms

Legs stiffen lastLegs stiffen last

Rigor MortisTime-lineRigor MortisTime-line

1-4 hours: Jaw and neck rigid, rest of body 1-4 hours: Jaw and neck rigid, rest of body limplimp

Up to 8 hours: everything down to the legs is Up to 8 hours: everything down to the legs is rigidrigid

For 12 hours: everything remains rigidFor 12 hours: everything remains rigid 24 hours: Jaw is limp, everything else is rigid24 hours: Jaw is limp, everything else is rigid 30-32 hours: everything but the legs are limp30-32 hours: everything but the legs are limp 36 hours: entire body is limp (no rigidity) 36 hours: entire body is limp (no rigidity)

decomposition has begundecomposition has begun

Circumstances affecting Circumstances affecting Rigor MortisRigor Mortis

StarvationStarvation

Extreme temperaturesExtreme temperatures

Physical exertionPhysical exertion

Effects of fireEffects of fire

or water (in the case of drowning)or water (in the case of drowning)

DecompositionDecomposition

Bacteria: CoBacteria: Co22 is produced, is produced, abdominal swellingabdominal swelling

Blood vessels: Blood vessels: discoloration of skin in upper abdomendiscoloration of skin in upper abdomen marbling effectmarbling effect Red → darker red → purple → greenRed → darker red → purple → green

Putracine – foul- smelling, Putracine – foul- smelling, nauseating odors nauseating odors

Algor MortisAlgor Mortis Either Liver temperature (LT) Either Liver temperature (LT)

or Rectal Temperature (RT)or Rectal Temperature (RT) Drop of about Drop of about

2 degrees 2 degrees

per hourper hour

Factors affecting temperature loss:Factors affecting temperature loss: Size (mass) of bodySize (mass) of body Body Temperature at deathBody Temperature at death Temperature of crime scene Temperature of crime scene

The Autopsy ExaminationThe Autopsy Examination““You've got to be the type of person who can You've got to be the type of person who can

emotionally disconnect [from] it. I mean, if you went emotionally disconnect [from] it. I mean, if you went into a case looking at it as, 'Geez, this is somebody's into a case looking at it as, 'Geez, this is somebody's little girl or somebody's little boy,' you'd never be able little girl or somebody's little boy,' you'd never be able to do the case. You can't personalize it in any way... to do the case. You can't personalize it in any way... When you walk in, you never forget that this is When you walk in, you never forget that this is somebody's loved one. You never forget that, but when somebody's loved one. You never forget that, but when you walk in to do the job, you kinda put that you walk in to do the job, you kinda put that information aside. You look at them more as a puzzle, information aside. You look at them more as a puzzle, and your job is to sort out this puzzle. and your job is to sort out this puzzle.

I've got to find out what happened. Who, what, I've got to find out what happened. Who, what, why, when, where. I mean, that's what my job is, to sort why, when, where. I mean, that's what my job is, to sort out and get those answers. And, do it in a respectful out and get those answers. And, do it in a respectful way. way.

A lot of people can't do this type of job. A lot of A lot of people can't do this type of job. A lot of people don't want to do this type of job. There are a lot people don't want to do this type of job. There are a lot of jobs I wouldn't want to do either.”of jobs I wouldn't want to do either.”

Eric KieselEric Kiesel Atlanta's Fulton County Deputy Chief Medical Atlanta's Fulton County Deputy Chief Medical

ExaminerExaminer

HISTORY OF HISTORY OF AUTOPSYAUTOPSY

EGYPTIONSEGYPTIONS 1600 BCE1600 BCE

HIPPOCRATES HIPPOCRATES – – 55THTH + 4 + 4THTH CENTURY BCE CENTURY BCE

AUTOPSIES TO DETERMINE THE CAUSE AUTOPSIES TO DETERMINE THE CAUSE OF DEATH:OF DEATH:

The Autopsy ExaminationThe Autopsy Examination

LegalityLegality Permission required – family can Permission required – family can

request an autopsy be performed request an autopsy be performed (usually free)(usually free)

Next of kin must sign autopsy permit.Next of kin must sign autopsy permit. Religious considerationsReligious considerations Mandatory when death is suspicious of Mandatory when death is suspicious of

foul play or if public health concern (in foul play or if public health concern (in most states)most states)

The Autopsy The Autopsy ExaminationExamination

Attending PersonnelAttending Personnel Diener – autopsy assistantDiener – autopsy assistant Prosector - pathologistProsector - pathologist Pathologist AssistantPathologist Assistant Precautions – protective Precautions – protective

clothingclothing

The Autopsy ExaminationThe Autopsy Examination

The External Exam = done first The External Exam = done first when body is examined.when body is examined. Looking for:Looking for:

WoundsWounds Contusions (Bruises)Contusions (Bruises) Unusual marks on the bodyUnusual marks on the body Overall impression of the bodyOverall impression of the body

Forensic AutopsyForensic Autopsy

An intensive search for informationTo locate PHYSICAL EVIDENCE to determine the cause of death

The Autopsy ExaminationThe Autopsy Examination

At this point, a general description of the At this point, a general description of the body is made. All identifying features are body is made. All identifying features are noted including: noted including:

Race Race Sex Sex Hair color and length Hair color and length Eye color Eye color Approximate age Approximate age Any identifying features (scars,tattoos, etc.) Any identifying features (scars,tattoos, etc.)

The Autopsy ExaminationThe Autopsy Examination

Opening the BodyOpening the Body Y-incision: incision made from left and Y-incision: incision made from left and

right shoulders to mid-chest and right shoulders to mid-chest and straight down to pubic region.straight down to pubic region.

No bleeding (usually) because there is No bleeding (usually) because there is no blood pressure.no blood pressure.

If head is to be opened, an incision is If head is to be opened, an incision is made across the head from one ear to made across the head from one ear to the other.the other.

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The Autopsy ExaminationThe Autopsy Examination

Rib cage is cut at the cartilage that Rib cage is cut at the cartilage that joins the ribs to the breastbone with joins the ribs to the breastbone with a scalpel, saw or knife to enter the a scalpel, saw or knife to enter the chest cavity. Soft tissue peeled back chest cavity. Soft tissue peeled back to look for abnormalities.to look for abnormalities.

Chest plate (ribs and breastbone) Chest plate (ribs and breastbone) are removed and examined. Often are removed and examined. Often fractured during CPR. fractured during CPR.

Skull is cut in front and Skull is cut in front and back for removal.back for removal.

The Autopsy ExaminationThe Autopsy Examination Removing and Examination of the Removing and Examination of the

OrgansOrgans Each organ is removed, photographed and Each organ is removed, photographed and

weighed. Organs are usually dissected and weighed. Organs are usually dissected and slides prepared to look for disease or slides prepared to look for disease or irregularities.irregularities.

THE HEARTTHE HEART

Checked for TRAUMA

Pulmonary arteryPulmonary artery

The The pulmonary arteriespulmonary arteries carry carry blood from the from the heart to the to the lungs. .

They are the only They are the only arteries (other than (other than umbilical arteries in the fetus) that carry in the fetus) that carry deoxygenated blood.deoxygenated blood.

Looking for a blood clot that has Looking for a blood clot that has dislodged from a vein traveling through dislodged from a vein traveling through the heartthe heart

To the pulmonary artery: SUDDEN To the pulmonary artery: SUDDEN DEATHDEATH

Blood samples are taken Blood samples are taken from the AORTAfrom the AORTA

Blood-typing and Blood/Alcohol Blood-typing and Blood/Alcohol testtest

Larynx and TracheaLarynx and Trachea

Checked for food bolus (choking)

Food lodged in trachea

LungsLungs

DrowningDrowning

DiatomsDiatoms

lungs

stomach

Blood stream

Bone marrow

Heroin UseHeroin Use

Carbonate crystals

Used to mix heroin

Will be found in the lungs

Death in firesDeath in fires

If aliveDuring

Fire there Will be

soot and ash in the Trachea

BronchiAnd

Lungs

If COIf CO22 levels in blood are greater levels in blood are greater

thanthan 2%2%

The victim was alive at the onset of The victim was alive at the onset of the firethe fire

Samples takenSamples taken

COCO2 2 and otherand other

gases in lungsgases in lungs

Microscopic slidesMicroscopic slides

LiverLiver

LiverLiver

A healthy liver:A healthy liver:

Soft, pliable, vulnerable to blunt-force Soft, pliable, vulnerable to blunt-force traumatrauma

Cirrhotic LiverCirrhotic Liver

Caused by hepatitus, malnutrition, drug & Caused by hepatitus, malnutrition, drug & alcohol usealcohol use

Jaundiced LiverJaundiced Liver

Kidneys – filter bloodKidneys – filter blood

The “Kidney Punch”The “Kidney Punch”

A World Boxing Association foulA World Boxing Association foul

Drug useDrug use

Drug addicts who have a cirrhotic Drug addicts who have a cirrhotic liverliver

cannot metabolize proteins……cannot metabolize proteins……

Toxins pass out of the liver andToxins pass out of the liver and

Damage kidneysDamage kidneys

Diseased KidneysDiseased Kidneys

Jaundiced kidneysPolycystic liver

StomachStomach

Important in drug-overdose casesImportant in drug-overdose cases

Helps establish activities prior to deathHelps establish activities prior to death

POISONSPOISONS

CYANIDECYANIDE

-red color of organs-red color of organs

-almond-like odor-almond-like odor

(only 50% of pop can detect the odor)(only 50% of pop can detect the odor)

-KCN used for executions-KCN used for executions

Estimated time of deathEstimated time of death

If TIME OF MEAL and MENU are If TIME OF MEAL and MENU are knownknown

IntestinesIntestines

Location of food can help determine time of death

Pair swallows 850 g Pair swallows 850 g cocaine..cocaine..

““Katriya Connor, 23, a chef from Waterloo in Katriya Connor, 23, a chef from Waterloo in Liverpool, became violently ill on a flight from Liverpool, became violently ill on a flight from Cancun in Mexico to Birmingham on February Cancun in Mexico to Birmingham on February 6, after scores of packets of cocaine that she 6, after scores of packets of cocaine that she had swallowed burst in her stomach. She died had swallowed burst in her stomach. She died within hours on an airport runway in the within hours on an airport runway in the Azores, where the flight had been diverted, Azores, where the flight had been diverted, while paramedics desperately tried to save her while paramedics desperately tried to save her life. A 21-year-old man, apparently travelling life. A 21-year-old man, apparently travelling with Ms Connor, also fell into a coma on the with Ms Connor, also fell into a coma on the flight and remains seriously ill on the island.”flight and remains seriously ill on the island.”

(from The Guardian)(from The Guardian)

Stomach of drug “mule”

Drug packets in rectum area

BladderBladder

URINE SAMPLE

Reproductive OrgansReproductive Organs

Inspected for pregnancy

(Teenage suicide)

The Brain The Brain

Removal of BrainRemoval of Brain

A blood clot caused by a blow to the head – can be fatal

Formaldehyde “fixes” the brain for better dissection

AutopsyAutopsy Conclusion Conclusion

Samples are obtained of bodily fluids Samples are obtained of bodily fluids and sent to toxicology for examination.and sent to toxicology for examination. BloodBlood UrineUrine BileBile

Manner and Cause of Manner and Cause of DeathDeath

MechanismMechanism – biochemical or – biochemical or physiological abnormality produced physiological abnormality produced by the cause of death that is by the cause of death that is incompatible with life.incompatible with life.

Manner of DeathManner of Death – homicide, – homicide, suicide, natural causes, accidental suicide, natural causes, accidental or undetermined. or undetermined.

CauseCause – disease or injury that – disease or injury that initiated the lethal chain of events initiated the lethal chain of events that lead to deaththat lead to death

Manner of DeathManner of Death

homicide homicide SuicideSuicide accidental – trauma occurring from accidental – trauma occurring from

acts acts NO REASONABLENO REASONABLE person person

would have felt have a high would have felt have a high probabilityprobability

of injury or deathof injury or death natural causenatural cause undetermined undetermined

Determination of Cause Determination of Cause of Deathof Death

One can die of a One can die of a massive hemorrhagemassive hemorrhage (the (the mechanismmechanism of death) due to a of death) due to a gunshot woundgunshot wound through the head (the through the head (the causecause of death) as a result of being of death) as a result of being shot (shot (homicidehomicide), shooting yourself ), shooting yourself ((suicidesuicide), dropping the gun and it ), dropping the gun and it discharging (discharging (accidentalaccidental), or not being ), or not being able to tell how it occurred able to tell how it occurred ((undeterminedundetermined). All of which are ). All of which are mannersmanners of death. of death.

Causes of DeathCauses of DeathBrain Damage:Brain Damage:

Subdural hematomaSubdural hematoma

Brain Brain Damage: Damage: Subarachnoid Subarachnoid hematomahematoma

Brain Damage: Brain Damage: Intracerebral hematoma:Intracerebral hematoma:

SuffocationSuffocation

Positional Positional AsphyxiationAsphyxiation

Positional Positional AsphyxiationAsphyxiation

SADSSADS

ChokingChoking

DrowningDrowning

Vomitos amigos: Vomitos amigos: Drug/alcoholDrug/alcohol

IntoxicationIntoxication

Neck InjuriesNeck InjuriesStrangulationStrangulation

accidental accidental

suicidesuicide

homicidehomicide

Petechial hemorrhagePetechial hemorrhageRuptures in the tiny capillariesRuptures in the tiny capillaries

Hyoid BoneHyoid Bone

HangingHanging

Nature of rope and knotsNature of rope and knots

Suicide by hangingSuicide by hanging

Male suicide Female suicide

Jugular veinJugular veinOn average, blood accounts for 8% of

total body weight5 to 6 liters of blood for

males

4 to 5 liters of blood for females

A 40 percent blood loss results in blood loss results in death.death.

The loss of 1.5 L canThe loss of 1.5 L can

cause incapacitation.cause incapacitation.Jugular vein

Stab Wounds: Stab Wounds: Sharp Force Trauma Sharp Force Trauma

Type of knife used (width, length, Type of knife used (width, length, single or single or double-edged)double-edged)

Stabbing woundsStabbing wounds

Slicing woundsSlicing wounds

Blunt Force TraumaBlunt Force Trauma

Caused by being struck by a flat Caused by being struck by a flat surfacesurface

Gunshot WoundsGunshot Wounds

International Gun International Gun StatisticsStatistics

Classification of Classification of Traumatic DeathTraumatic Death

Four Categories:Four Categories: ThermalThermal Chemical Chemical ElectricalElectrical MechanicalMechanical

Asphyxiation – interference of oxygen Asphyxiation – interference of oxygen to brainto brain Can be caused by all mechanismsCan be caused by all mechanisms

Mechanical TraumaMechanical Trauma

Blunt or SharpBlunt or Sharp Penetrating or Non-penetratingPenetrating or Non-penetrating Mechanical Trauma occurs when the Mechanical Trauma occurs when the

applied physical force exceeds applied physical force exceeds tensile strength of the tissue, tensile strength of the tissue, causing lacerations (blunt force) or causing lacerations (blunt force) or incised wounds (sharp)incised wounds (sharp)

Mechanical TraumaMechanical Trauma

Sharp Force TraumaSharp Force Trauma Most common cause of death = Most common cause of death =

exsanguinationexsanguination Major arteries or the heart are damagedMajor arteries or the heart are damaged

Blunt Force TraumaBlunt Force Trauma Cause contusions or lacerationsCause contusions or lacerations Most common cause of death = Most common cause of death =

significant damage to brain or internal significant damage to brain or internal bleedingbleeding

Mechanical TraumaMechanical Trauma

Firearm InjuryFirearm Injury Contact wound – blackening of skin Contact wound – blackening of skin

around wound (gas “burns” skin), small around wound (gas “burns” skin), small in sizein size

Distant wound – circular skin defect and Distant wound – circular skin defect and rim of abraded skin around the edgesrim of abraded skin around the edges

Exit wound is Exit wound is larger and more irregularlarger and more irregular than entry wound.than entry wound.

Chemical TraumaChemical Trauma

Death that results from drugs or poisonsDeath that results from drugs or poisons Alcohol = most common drug that causes Alcohol = most common drug that causes

deathdeath Rarely kills directly, but contributes to about Rarely kills directly, but contributes to about

50% of traumatic deaths.50% of traumatic deaths. Other chemicals: Other chemicals:

DrugsDrugs Carbon Monoxide Carbon Monoxide Cyanide / Arsenic (poisons)Cyanide / Arsenic (poisons)

Thermal TraumaThermal Trauma Exposure to excessive heat or coldExposure to excessive heat or cold

Hypothermia – excessive coldHypothermia – excessive cold Hyperthermia – excessive heatHyperthermia – excessive heat

Causes death via a breakdown in the Causes death via a breakdown in the normal mechanisms that maintain normal mechanisms that maintain body temperature.body temperature.

Thermal Burns – death usually occurs Thermal Burns – death usually occurs as a result of complications (shock; as a result of complications (shock; mechanism = multiple organ failure)mechanism = multiple organ failure)

Cause of death in fires – inhalation of Cause of death in fires – inhalation of CO, not burnsCO, not burns

Electrical TraumaElectrical Trauma

Passage of electricity through a personPassage of electricity through a person Low Voltage – heart experiences Low Voltage – heart experiences

ventricular fibrillation (quivering of the ventricular fibrillation (quivering of the heart; beats faster than the body can heart; beats faster than the body can handle)handle)

High Voltage – forces heart into tetany, a High Voltage – forces heart into tetany, a contraction that is broken when the contraction that is broken when the circuit is broken. Heart generally starts circuit is broken. Heart generally starts again with a normal rhythmagain with a normal rhythm

Loss of limbs or electrical burns are possible Loss of limbs or electrical burns are possible within seconds of shock.within seconds of shock.